Academic journal article Central European Journal of Public Health

Prevalence and Risk Factors of Osteoporosis in Postmenopausal Women with Type 2 Diabetes Mellitus

Academic journal article Central European Journal of Public Health

Prevalence and Risk Factors of Osteoporosis in Postmenopausal Women with Type 2 Diabetes Mellitus

Article excerpt

INTRODUCTION

Type 2 diabetes mellitus (T2DM) and osteoporosis are frequent metabolic disorders that belong to the most important causes of mortality and morbidity in elderly population. It has become apparent that patients with T2DM are at higher risk of fracture (1, 2) despite the evidence that T2DM patients present generally normal or increased bone mineral density (BMD) (3). Resulting from the presence of other diabetic complication, such as diabetic neuropathy or retinopathy or appearance of hypoglycemic episodes, the increased risk of fall is evident, especially in older adults with T2DM. Also other factors influence the risk of osteoporosis in T2DM patients including low calcium diet, vitamin D insufficiency, physical inactivity, smoking, and also genetic predisposition. However, the exact underlying mechanism leading to higher bone fragility inT2DM patients is not fully understood. Altered bone quality rather than bone mass reduction seems to play an essential role in the pathogenesis of bone fragility in these patients. The bone quality depends on the bone microarchitecture, bone remodelling and bone matrix properties that can be influenced by age, hyperglycemia and accumulation of advanced glycation end products (AGEs) within the bone or a loss of muscle mass and/or muscle strength (4). AGEs pathological effects are possibly suppressed by the soluble receptor for advanced glycation end products (sRAGE). Gene polymorphism of the receptor for advanced glycation end products (RAGE) was associated with serum circulating sRAGE (5). Studies regarding the bone metabolism have observed that low serum levels of sRAGE were associated with an increased risk of vertebral fractures (6) and accumulation of AGEs in the bone disturbs the bone remodelling (7). Differences in bone remodelling have been explored in T2DM (8, 9), several studies have reported lower serum osteocalcin levels in patients with T2DM than control subjects (10). In nondiabetic population, markers of bone remodelling are shown to predict fracture (11). Since BMD is not sufficient to predict fracture in T2DM population, other indicators of poor bone quality and higher bone fragility in T2DM patients need to be assessed. One of the promising markers is sclerostin that is produced by osteocytes, it acts as negative regulator of bone formation and mediates the bone response to mechanical unloading through antagonizing Wnt/beta-catenin signaling (12). Circulating sclerostin levels found in T2DM patients were higher than in control subjects without T2DM (13).

The aim of our study was to analyze the prevalence and risk factors of osteoporosis and/or low trauma fractures, biochemical markers of bone remodelling and to investigate the role of sRAGE and its gene polymorphism in postmenopausal women with T2DM and control nondiabetic subjects.

MATERIALS AND METHODS

Our cross-sectional study comprised a convenience sample of postmenopausal women with T2DM and control subjects. From October 2011 to October 2013, we recruited postmenopausal women who attended a preventive bone mineral density (BMD) measurement. All the participants received a standardized questionnaire on osteoporosis risk factors regarding the fracture prevalence, physical activity, smoking and dairy products intake. The fracture related questions were detailed with respect to skeletal location, date of fracture occurrence (year) and trauma severity. Vertebral and typical nonvertebral fractures, namely hip, forearm, rib, tibia, humerus, and other fractures were analyzed; but not typical osteoporotic fractures, e.g. fractures of fingers were excluded. A fracture occurring spontaneously or after a fall from standing position was defined as a low trauma fracture. Fractures caused by traumatic events were excluded from the analysis. Furthermore, standardized questions on the history of diabetes were included in the questionnaire, including diabetic specific parameters (therapy, duration of diabetes). …

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